10 Blood Pressure Pressure of arterial blood is regulated by blood volume, TPR, and cardiac rate. Arteriole resistance is greatest because they have the smallest diameter. Capillaries BP is reduced because of the total crosssectional area. 3 most important variables are HR, SV, and TPR. Fig Fig Fig Fig

11 Atrial Stretch Reflexes Located in the atria of the heart. Receptors activated by increased venous return. Stimulate reflex tachycardia. Inhibit ADH release. Promote secretion of ANF. Measurement of Blood Pressure Auscultation: Art of listening. Laminar flow: Normal blood flow. Blood in the central axial stream moves faster than blood flowing closer to the artery wall. Turbulent flow and vibrations produced in the artery when cuff pressure is greater than diastolic pressure and lower than systolic pressure. YIKES!!! Measurement of Blood Pressure Fig Different phases in measurement of blood pressure are identified on the basis of the quality of the Korotkoff sounds. Average arterial BP is 120/80. Average pulmonary BP is 22/8. Fig

12 Recall: Pulse Pressure The expansion of the artery in response to the volume of blood ejected. Pulse pressure = systolic pressure diastolic pressure Mean arterial pressure: Average arterial pressure during the cardiac cycle. Is closer to diastolic pressure, as the period of diastole is longer than the period of systole. Mean arterial pressure = diastolic pressure + 1/3 pulse pressure Hypertension Blood pressure in excess of normal range for age and gender. > 140/90 mm Hg. Primary or essential hypertension: Result of a complex or poorly understood process. Secondary hypertension: As a result of a known disease. Essential Hypertension 95% of population with hypertension. Increase in TPR is a universal characteristic. Secretion of renin, angiotensin II, and aldosterone is variable. Sustained high stress (via SNS) and high Na + intake act synergistically in development of hypertension. Adaptive response is thickening of arterial wall, resulting in atherosclerosis. Kidneys may not be able to properly excrete Na + and H 2 0. Dangers of Hypertension Silent killer: Patients are asymptomatic until substantial vascular damage occurs. Atherosclerosis. Increases afterload. Increases workload of the heart. Congestive heart failure. Damage cerebral blood vessels. Stroke. Treatment of Hypertension Modification of lifestyle: Cessation of smoking. Moderation in alcohol intake. Weight reduction. Reduction in Na + intake. Medications (exercise: work out how these counteract hypertension) Diuretics. Beta-blockers. Calcium antagonists. ACE inhibitors. Circulatory Shock Hypovolemic shock: Circulatory shock that is due to low blood volume. Decreased Cardiac Output and blood pressure. Compensations: Baroreceptor reflex: Tachycardia. Vasoconstriction to GI, skin, kidneys and muscles. Kidneys stimulate production of renin-angiotensinaldosterone system. Increase in ADH. 12

13 Circulatory Shock Septic shock: Dangerously low blood pressure as a result of sepsis. Occur through the action of endotoxin. Endotoxin activates nitric oxide synthetase, producing NO. NO causes vasodilation. Treat with drugs that inhibit the production of NO. Congestive Heart Failure Cardiac output is insufficient to maintain the blood flow required by the body. Caused by: MI (most common cause). Congenital defects. Hypertension. Disturbances in electrolyte concentrations. K + and Ca ++. Compensations similar to those of hypovolemic shock. Treated with medications: Digitalis and vasodilators, and diuretics. 13

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